Ultra-lung-protective ventilation and biotrauma in severe ARDS patients on veno-venous extracorporeal membrane oxygenation: a randomized controlled study
Christophe Guervilly,
Théotime Fournier,
Juliette Chommeloux,
Laurent Arnaud,
Camille Pinglis,
Karine Baumstarck,
Mohamed Boucekine,
Sabine Valera,
Celine Sanz,
Mélanie Adda,
Mickaël Bobot,
Florence Daviet,
Ines Gragueb-Chatti,
Jean-Marie Forel,
Antoine Roch,
Sami Hraiech,
Françoise Dignat-George,
Matthieu Schmidt,
Romaric Lacroix,
Laurent Papazian
Affiliations
Christophe Guervilly
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Théotime Fournier
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Juliette Chommeloux
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne, Université Hôpital Pitié- Salpêtrière
Laurent Arnaud
Laboratoire d’Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille
Camille Pinglis
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Karine Baumstarck
Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université
Mohamed Boucekine
Centre d’Etudes et de Recherches sur les Services de Santé et qualite de vie EA 3279, Aix-Marseille Université
Sabine Valera
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Celine Sanz
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Mélanie Adda
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Mickaël Bobot
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Florence Daviet
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Ines Gragueb-Chatti
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Jean-Marie Forel
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Antoine Roch
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Sami Hraiech
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Françoise Dignat-George
Laboratoire d’Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille
Matthieu Schmidt
Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP, Sorbonne, Université Hôpital Pitié- Salpêtrière
Romaric Lacroix
Laboratoire d’Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille
Laurent Papazian
Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille
Abstract Background Ultra-lung-protective ventilation may be useful during veno-venous extracorporeal membrane oxygenation (vv-ECMO) for severe acute respiratory distress syndrome (ARDS) to minimize ventilator-induced lung injury and to facilitate lung recovery. The objective was to compare pulmonary and systemic biotrauma evaluated by numerous biomarkers of inflammation, epithelial, endothelial injuries, and lung repair according to two ventilator strategies on vv-ECMO. Methods This is a prospective randomized controlled study. Patients were randomized to receive during 48 h either ultra-lung-protective ventilation combining very low tidal volume (1–2 mL/kg of predicted body weight), low respiratory rate (5–10 cycles per minute), positive expiratory transpulmonary pressure, and 16 h of prone position or lung-protective-ventilation which followed the ECMO arm of the EOLIA trial (control group). Results The primary outcome was the alveolar concentrations of interleukin-1-beta, interleukin-6, interleukin-8, surfactant protein D, and blood concentrations of serum advanced glycation end products and angiopoietin-2 48 h after randomization. Enrollment was stopped for futility after the inclusion of 39 patients. Tidal volume, respiratory rate, minute ventilation, plateau pressure, and mechanical power were significantly lower in the ultra-lung-protective group. None of the concentrations of the pre-specified biomarkers differed between the two groups 48 h after randomization. However, a trend to higher 60-day mortality was observed in the ultra-lung-protective group compared to the control group (45 vs 17%, p = 0.06). Conclusions Despite a significant reduction in the mechanical power, ultra-lung-protective ventilation during 48 h did not reduce biotrauma in patients with vv-ECMO-supported ARDS. The impact of this ventilation strategy on clinical outcomes warrants further investigation. Trial registration Clinical trial registered with www.clinicaltrials.gov ( NCT03918603 ). Registered 17 April 2019.
